Thirty years of home mechanical ventilation in children: escalating need for pediatric intensive care beds

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Intensive Care Medicine

, Volume 38, Issue 5, pp 847–852

First Online: 05 April 2012Received: 10 June 2011Accepted: 02 March 2012

Abstract

PurposeTo describe trends in pediatric home mechanical ventilation HMV and their impact on the use of pediatric intensive care unit PICU beds.

MethodsReview of all children who had started HMV in a single center for HMV.

ResultsBetween 1979 and 2009, HMV was started in 197 patients 100 51 % with invasive and 97 with noninvasive ventilation, with a median age of 14.7 range 0.5–17.9 years. Most patients 77 % were males with a neuromuscular disorder 66 %. The number of children receiving HMV increased from 8 in the 1979–1988 period to 122 in the 1999–2008 period. This increase occurred foremost in patients aged 0–5 years and was accompanied by a sharp rise in the use of PICU beds. In 150 patients 76 %, HMV was initiated on an ICU with a total of 12,440 admission days, of which 10,385 days 83 % could be attributed to 67 patients who started non-electively with invasive HMV. Of the latter, 52 patients had been admitted to a PICU with a total of 9,335 admission days. At the end of the study, 134 patients 68 % were still being ventilated, 43 patients 22 % had died, 11 patients 6 % were weaned from HMV, 4 patients 2 % did not want to continue HMV and 5 patients 3 % were lost to follow-up.

ConclusionsOver time, there was an impressive increase in the application of HMV in children. This increase was most obvious in the youngest age group with invasive HMV, and these children had very long stays in the PICU.

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